Randomized controlled trials show us as much as they can if one technique is better than another. We have forgotten that what makes our identity as a profession is tailored decisions on which and how much of each intervention must be multi-modally packaged based on the patient’s clinical findings, psychosocial profile, socio-cultural background, and evidence. We have lost our direction: physiotherapy knowledge suffers from ups and downs. Most recently, because of an ‘overdose’ of neuroscience, many pretend to only ‘talk’ to patients to cure them from persistent spinal pain, without possessing proper skills in that field, and forgetting that touch is an essential aspect of our professional identity. We spent also decades demonstrating how mobilizations were at least as effective as high-velocity low-amplitude thrust manipulations and developing non-informative screening tools to support the anecdotical belief of manipulation risks. We lost years in obsessively supporting clinical prediction rules that are so far from the clinical reasoning process–a core musculoskeletal physiotherapy competence. transversus abdominis and deep neck flexors) to provide more stability to the spine.
In managing spine disorders we moved from abdominal strengthening, to releasing hypomobile segments, to reinforcing certain muscles ‘selected by good’ (i.e. In managing patellofemoral pain, the physical therapy profession trends moved from the ‘selective’ strengthening of the Vastus Medialis Obliquus muscle to taping the patella to correct its position or tracking, to ‘change’ the femoral bone position by reinforcing the gluteal muscles or using motor control strategies. This is only the latest episode of a long story. Comparing apples to oranges, telerehabilitation has rapidly become a new and widely discussed revolutionary discovery contributing to the ‘evolution’ of our profession, replacing office-based physiotherapy, often without proper consideration of risk and liability. Just before the pandemic, telerehabilitation was just a promising addition to traditional intervention offering a new perspective for selected patients. During the time of COVID-19 health emergency a new approach to patient care has emerged: telerehabilitation.
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